Vesicoureteral Reflux—Adult

(VUR; Reflux Nephropathy; Chronic Atrophic Pyelonephritis; Vesico-Ureteric Reflux; Ureteral Reflux)

Pronounced: VEH-sih-co-ya-REET-uh-rul REE-flux

by Sonja Lyons

Definition

Vesicoureteral reflux (VUR) is the backward flow of urine. It flows from the bladder back into the ureters or kidneys.

Anatomy of the Urinary System

Causes

Urine flows down from the kidneys. It passes through tubes called ureters and into the bladder. This keeps urine moving one way. If there are problems, urine can flow back into the kidney.

Primary causes are a direct result of problems in the urinary system. Secondary causes result from causes that may block normal flow. These may involve:

Genetic problems passed down from a parent
The ureter doesn’t attach far enough inside the bladder
Weak muscles in the lower part of the bladder
Blockage that keeps urine from moving freely
Nerve problems that keep the bladder from working as it should— neurogenic bladder
A bulging muscle where the ureter goes into the bladder—ureterocele
Structural problems that happen as you get older

Risk Factors

Your risk is higher if you:

Are female
Are White
Had childhood VUR
Have people in your family with the same problems
Have structural problems
Have frequent urinary tract infections (UTIs)
Have bladder or bowel problems

Symptoms

VUR doesn't cause problems in most people. In those that have symptoms, VUR may cause:

Frequent or urgent need to use the bathroom
Weak stream
Stops and starts while passing urine
Pain in the lower back or side

Diagnosis

The doctor will ask about your symptoms and health history. Your answers and a physical exam may point to VUR. You may also have:

Blood tests
Urine tests
Ultrasound
Dimercaptosuccinic acid (DMSA) scan
Voiding cystourethrogram (VCUG)
Cystoscopy

Treatment

VUR in adults doesn’t go away on its own. Care centers on treating the cause. This will also help lower the chances of scarring.

Medicines

The doctor may give you medicines to treat:

Infections
High blood pressure
Protein in the urine

Surgery

If other methods don’t fix the problems, you may have surgery. This may involve:

Cystoscopic injection—a substance is added where the ureter and bladder meet
Ureteral reimplantation—to reposition the ureters in the bladder

Prevention

To help lower your chances of VUR:

Seek early care if you think you have a UTI.
If you are pregnant, go to all your tests as scheduled.
Your doctor may give you antibiotics to if you have frequent UTIs.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https//www.niddk.nih.gov

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The Kidney Foundation of Canada
https://www.kidney.ca

References:

Freidman AA, Hanna MK. Vesicoureteral reflux and the adult. In: Wood HM, Woods D, ed. Current Clinical Urology. Springer International Publishing;2015:173-205.

Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis. 2011;18(5):348-54.

Rollino C, D'Urso L, Beltrame G, Ferro M. Vesicoureteral reflux in adults. G Ital Nefrol. 2011;28(6):599-611.

Last reviewed May 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 6/13/2018

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